Contributing Institution:
San Francisco History Center, San Francisco Public Library

Abstract: Records documenting the formation and activity of the AIDS Office, including files of Directors of Public Health, Mervyn Silverman
and David Werdegar, prior to the Office's creation in 1985, followed by successive directors of the Office itself; records
from four of the five branches of the AIDS Office, including Fiscal Services, Health Services, Prevention, and Surveillance;
and records documenting the contracts process, including grant requests, Request for Proposals (RFPs) from and contracts with
community-based organizations, working folders, contract processing and development files, reports, and other materials. Includes
substantial material on programs and organizations funded by the Ryan White CARE Act, which provides federal money for AIDS
services.

Physical Location: The collection is stored offsite.

Language of Material:
English

Language of Material: Collection materials are in English.

Access

The collection is available for use during San Francisco History Center hours, with photographs available during Photo Desk
hours. Collections that are stored offsite should be requested 48 hours in advance.

Publication Rights

All requests for permission to publish or quote from manuscripts must be submitted in writing to the City Archivist. Permission
for publication is given on behalf of the San Francisco Public Library as the owner of the physical items.

Preferred Citation

[Identification of item], AIDS Office of the San Francisco Department of Public Health Records (SFH 4), San Francisco History
Center, San Francisco Public Library.

Provenance

Transfer; Special Collections, University of California, San Francisco; May 14,1997.

Related Materials

Related archival materials in this repository include: People vs. Owen Bathhouse Closure Litigation Records, 1984-1987 (SFH
31), which includes records from the Bureau of Communicable Disease Control, San Francisco Department of Public Health.

Administrative History

The AIDS Office of the San Francisco Department of Public Health (SFDPH) is responsible for all non-acute AIDS activities
administered by the city, including surveillance, research, administration and oversight of much of the city, state, and federal
funding of AIDS-related services; coordination of non-acute care services for people with AIDS (PWAs) and HIV+ people; coordination
of AIDS education and prevention programs; and planning and policy development related to AIDS for the city. Information the
AIDS Office collects is also passed on to appropriate state and federal offices (CDC, NIH, etc.) to help them understand what
is occurring with AIDS and AIDS-related services in San Francisco. It was formed in 1985 from the merging of the AIDS Activities
Office (formed in 1984) and the AIDS Surveillance Unit of the Bureau of Epidemiology and Disease Control.

The initial response to the AIDS epidemic by the San Francisco Department of Public Health (SFDPH) was centered in the Bureau
of Epidemiology and Disease Control, which, until 1985, was the site of most AIDS-related surveillance operations within
San Francisco. In addition, in 1984 the AIDS Activities Office was formed to identify needs, address health education, and
arrange for funding of AIDS-related services in San Francisco, with Jeff Amory, Michael Bala and Gary Titus as the initial
staff.

AIDS-related policy development and planning has also been done within the office of the Director of Public Health. Mervyn
Silverman was Director during the first half of the 1980s, handling numerous explosive issues such as the bathhouse dispute
of 1984. David Werdegar replaced him in 1985, followed by Dr Raymond Baxter in 1990. Dr Sandra Hernandez, former head of the
AIDS Office, was selected to succeed Baxter in 1994.

In 1985, the AIDS Activities Office and what was by then called the AIDS Surveillance Unit (ASU) of the Bureau of Epidemiology
and Disease Control were combined to form the AIDS Office. Dr George Rutherford was appointed Director, with Jeff Amory as
Administrative Director. Bala and Titus from the AIDS Activities Office and Tim Piland and Nancy Hessel from the ASU were
all moved into the AIDS Office. In 1986, the AIDS Office moved from SFDPH headquarters at 101 Grove to 1111 Market. It outgrew
that space and moved to its present location at 25 Van Ness in 1989. Rutherford was replaced by Dr Sandra Hernandez in 1990.
Hernandez accepted a new position in late 1992, and Mitchell Katz was appointed head of the AIDS Office.

During the last half of the 1980s, the AIDS Office grew rapidly, and an increasing number of contracts were awarded to an
ever-larger number of organizations. Initially, many contracts were simply bestowed by the AIDS Office to agencies already
performing work in the area being funded. This was an informal process; no bidding system had been established, and much of
the decision-making was done by the AIDS Office's Administrative Director, Jeff Amory. By the late 1980s, requests for proposals
(RFPs) began to be sent out, and a more conventional bidding process ensued. Information from the Surveillance Branch of the
AIDS Office was used to develop RFPs that targeted specific needs. One of the needs recognized by the AIDS Office at this
time arose as a result of information gained from a number of surveys conducted by the Surveillance Branch. These surveys
demonstrated that the needs of men of color were not being adequately addressed. The AIDS Office's response was to develop
RFPs that specified community-based models. This was the factor that initially encouraged people of color to form their own
agencies with services based on the cultural norms of their particular communities. A major problem with this approach slowly
became evident; gay men were generally outside the community norms required by the AIDS Office. This was partially dealt with
by careful attention to language, and it was based on the strategy that terms like "gay men" or other identity-based descriptors
were supplanted with alternative terms, such as "men who have sex with men," which described targets on the basis of behavior.

In 1990, the United States Congress passed the Ryan White CARE Act, which provides a great deal of money for direct services
to the cities most affected by AIDS. This was a significant moment in the history of AIDS services in the United States, both
for the sharp increase in federal funding and because of the apparatus it set up to distribute those funds. In San Francisco,
a consortium of individuals active in providing or using AIDS services was formed as the Ryan White CARE Council (hereafter
simply the CARE Council). The Director of the AIDS Office, or the Director's agent, acts as coordinator of the CARE Council.
After it was formed, funding decisions were no longer made solely by the AIDS Office; the CARE Council as a whole conducted
much of the planning and set goals for the dispersal of CARE funds. However, the actual bidding and awarding of contracts
funded by CARE monies remains in the hands of the AIDS Office. Another change evident since 1990 has been the increasing tendency
of the AIDS Office to develop RFPs for collaborative programs. This occurred because the AIDS Office, and the CARE Council,
became convinced that joint contracts create stronger and more effective programs, as different levels of administrative skills,
knowledge of the client population, and experience among agencies could enhance the quality and quantity of services.

Scope and Contents

Although the following boundaries are somewhat arbitrary, it seems useful to group AIDS-related records from the SFDPH into
three groups, characterized by age, in order to discuss what is documented in this collection.

• Pre-AIDS Office (1981-1985): While this period is sparsely represented here, there are some significant records present.
Most pertinent documents can be found in the files of Dr Silverman (carton 1), and Dave Rutherford (carton 3). The bulk of
Dr Silverman's records, records of the AIDS Activities Office, and AIDS-related records from the Bureau of Epidemiology and
Disease Control, have apparently not survived.

• Early AIDS Office (1985 through 1990): Many cartons from this period have been retained. Besides contracts, the largest
number are in the files of Doctors Werdegar, Rutherford, and Hernandez. Files can also be found in records of the Health Services
and Prevention Branches.

• Recent AIDS Office (1991 through 1995): The initial dispersal of funds under the Ryan White CARE Act in early 1991 marks
the boundary between the categories of Early AIDS Office and Recent AIDS Office. Many feet of files from this period are held.

The AIDS Office has five Branches. The Fiscal Services Branch (formerly called the Operations Branch) coordinates and manages
funds from federal, state and local governments. It is subdivided into four functional sections: Grants (funds from government
to the AIDS Office), Requests for Proposals, Contracts (funds to organizations from the AIDS Office), and Fiscal Management.
This collection holds records of all of these areas, though records of Grants were generally not accessioned. The majority
of Fiscal Services records are in Contracts and Related Documents (Cartons 23-64), although Budgets are in Carton 14, and
some administrative files are in Carton 22.
The Health Services Branch coordinates non-acute care services for People with AIDS or HIV (PWAs). These services cover six
areas: Primary Medical Care, Home Care & Mental Health, Psychosocial Support, Housing, Substance Abuse Treatment, and Case
Management. Records of this branch, mostly from the late 1980s, are found in Cartons 13 and 14. Other records that relate
to Health Services are scattered throughout Administrative Files (Cartons 1-10). A small set of papers (1989-91) of the AIDS
Health Services Advisory Committee are located in Carton 11. Files documenting the HIV Health Services Care Council and CARE
Funding are located in
Cartons 18-22. Many of the Contracts and Related Documents (Cartons 23-64) involve Health Services also.

The Prevention Branch coordinates AIDS education and information services. It also conducts behavioral surveys and program
evaluation. Major audiences targeted for AIDS prevention services include gay/bi men, injection drug users and their sexual
partners, women, and adolescents. Prevention-related records are located in Cartons 14-17 as well as in Contracts and Related
Documents (Cartons 23-64). Records relating to HIV Testing Services are held in Carton 17-18.

The Research Branch conducts a variety of studies on a cohort of 6,705 gay or bi men who were originally recruited at the
city's VD clinic between 1978 and 1980 for a study on hepatitis B. No records from the
Research Branch are held in this collection.

The Surveillance Branch documents the nature and scope of the epidemic by tracking, and making projections about, morbidity
and mortality related to AIDS in San Francisco. This branch also keeps its own non-current records, including the complete
files of the AIDS Registry. These are confidential files and are not available for research. The only files included from
the Surveillance Branch are various reports, surveys and
projections held in Carton 22.

For a more detailed discussion of the organization of the AIDS Office and responsibilities of the Branches, see the "History
and Description" file at the front of Carton 1.

The first 12 cartons of this collection are from the Administrative Offices of the AIDS Office. These are files of the Director
of Public Health, the Director of the AIDS Office, and the Assistant Director of the AIDS Office. These files document activities
and problems from each branch and from many AIDS organizations. Others deal with politicians, legislation, extra-governmental
bodies, and a wide range of issues related to AIDS. Of particular note are the Troubleshooting Files (Cartons 7-8, 10) which
document problems with particular contracting agencies and how these problems were handled. Additional important sources are
minutes and other documents of various internal committees, advisory bodies to the AIDS Office, and external groups organized
around specific needs (Cartons 110-12). Minutes of some of these groups, such as the Minority AIDS Advisory Committee, which
was renamed the People of Color AIDS Advisory Committee in 1990, have been compiled from both within the AIDS Office and from
the records of several community-based organizations with representatives on these committees. Files on a few groups hold
meager records; these were retained to document the existence of these bodies. The last two cartons are late additions. Carton
65 holds long-range planning records. Carton 66 holds reports, KAABs, and other monographs published by the SFDPH or other
agencies of the city of San Francisco.

The financing of AIDS-related activities is a factor critical to understanding the growth, development, and history of the
response to the epidemic. While funding comes from a variety of sources, by far the largest portion is from governmental funds.
In San Francisco, most federal, state and city funds for AIDS services are provided through
contracts awarded and/or monitored by the AIDS Office of the Department of Public Health. The development of funding priorities,
specific proposals by various agencies, contract development, and contract monitoring and reporting activities provide the
broadest perspective for understanding the development of AIDS-related services in San Francisco; this arena, referred to
as the contract process, is described below.

In a nutshell, the AIDS Office obtains grants of money from various governmental sources (CDC, Ryan White Care Funds, NIAID,
Title II, etc), generally earmarked for specific purposes. The AIDS Office looks at these grants and at local needs, and decides
on more specific criteria for funding. It then sends out a general announcement of funds available and solicits proposals
from agencies (these solicitations are commonly known as RFPs, or Requests for Proposals). Individual agencies then apply
for funding on a competitive basis. Those applications with the most well-written and best-documented proposals are approved.
Awards are made on the basis of preset evaluation criteria set by the AIDS Office and clearly spelled out in the RFP. Those
chosen will be awarded a Contract which stipulates exactly what is to be done, how funds are to be used, and what kind of
reporting back to the AIDS Office is needed. Monitoring of these reports, as well as actual site visits and audits, ensure
that the contracting agencies fulfill the terms of their contracts and that funds are spent on authorized, needed services.
They also provide the AIDS Office, and now the CARE Council, with data about the utility and effectiveness of particular services
and educational efforts. This data, in turn, provides information useful in targeting specific needs and planning for future
funding cycles. Thus, the contract process is cyclical in nature, with planning for the future developed from lessons of the
past. Although these documents may not be intuitively understood, a careful reading can produce a week-by-week, month-by-month
chronicle of the details of AIDS services in San Francisco.

To help comprehend these documents, a list of definitions of common terms used in the contract process follows:

Definitions of Contract Terminology Used at AIDS Office, SFDPH
Thanks to Galen Leung, former Director

Budget: AIDS Office contract budgets were not very detailed before 1991 but are key to finding out what was paid for by the
City and what was supported by donations.

Budget Justification: Detailed explanations for each line of the budget; useful for understanding exactly what was paid for.

Contract: A legal and binding agreement detailing services provided for a set sum of money; a contract consists of a contract
boilerplate of legal language; a narrative describing the need, the services to be provided, the methodology for providing
the services, the target population, the quality assurance, and the timelines for delivering services; a budget; a sample
invoice; and a set of insurance accords. Contracts are effective
only when the Controller's Office certifies the accompanying encumbrance document: a Contract Order, but the contract must
first go through the City system & gain approval from 6 different bodies before it can get the
7th approval.

Contract Development Documents: Term used to refer to all pre-Contract documents.

Contract File: File with only the signed and certified contract and encumbrance document (contract order).

Correspondence: Letters & memos between a contractor and the AIDS Office person in charge of the contract.

CRDC: Cost Report & Data Collection (form); not found in AIDS Office contracts but used by staff overseeing mental health
and substance abuse services for their contracts.

Grant : Funds received by AIDS Office which do not originate from San Francisco; these funds may be used to support civil
servants, contractual service providers, and operating expenses. Often, organizations label any
set of funds coming into the organization as grant funds to distinguish these funds from contracts, which are funds leaving
the organization.

Monitoring Report : Monitoring is an activity administered by the Program Branches (Prevention and Health Services); copies
of Monitoring Reports are part of the Working Folders. A summary of efforts to review and
assess a set of contractual services, the report summarizes responses to a protocol, findings from a team of community experts
(non-AIDS Office persons), findings from an AIDS Office team that reviews fiscal and
administrative policies and procedures, and corrective actions to be taken along with timelines. Most reports are the result
of site visits by a monitoring team; however, a number of reports are based on a review of
client records without an in-depth site visit. The report records the performance of a contractor.

Processing Documents : Documents needed to process a contract through the seven bodies for approval; these documents are usually
found in the working folder and include summaries for the Civil Service Commission,
Human Rights Commission, and Health Commission and accounting documents.

Quarterly Reports: Demographic and risk-factor data of clients from each contractor; form changed each year.

RFP (Request for Proposal): a competitive method to select a provider for a service; the process involves advertisements and
mailings, a description of services to be performed, forms to fill out, a bidders' conference, minutes to the conference,
proposals from each organization, a technical review team that is usually composed of community experts (non-AIDS Office persons),
criteria by which to score each proposal, score sheets, a report on each proposal's strengths and weaknesses, the team's report/recommendation,
and the final decision by the head of the office. Each RFP is numbered and corresponds to a service or a set of services;
the number sequence uses 5 digits (015-94; the last two figures for the year of the RFP and the first 3 figures for the ordinal
place (so 015-94 means the 15th RFP in calendar year 1994). RFPs must be approved by the staff of the Human Rights
Commission.

Sole Source: A non-competitive method to select a provider for a service; also a justification for the selection of a provider
when an RFP is not used; sole sources must be approved by the Health Commission and the staff of the Human Rights Commission.

UDC (Unduplicated Clients): the number of individuals served by a contractor or a program.

UOS (Units of Service): e.g., hours of case management services.

Working Folders/Working Papers: Files with uncertified copies of the contract narrative and budget, demographic information
forms, correspondence, monitoring reports, insurance documents, and a cover memo to the Health Commission. As currently used
by the Fiscal Services Branch, Working Folders are usually the most complete record of the contract process. They are generally
preferred to the contracts themselves, unless there have been changes made in the actual contract, which may be reflected
only in the certified copy.

Arrangement

The collection is organized in two record groups: Record Group 1: Administrative Records and Record Group 2: Contracts and
Related Documents. Record Group 1 is arranged in three subgroups: Subgroup 1: Director's Office; Subgroup 2: Branch Files;
and Subgroup 3: CARE Files.